Financial and operational considerations for hospital adoption of the DaVinci robotic surgery system

Health Care Finance

There are a number of factors than at organization should consider with respect to the DaVinci robotic surgery system. The system is costly, and there is a fairly small body of evidence with regards to its effectiveness, so this is a decision that hospital management needs to take seriously.

Patient care is the primary objective of any health care facility. There are mixed views with respect to the DaVinci system. The company's fact sheet highlights benefits such as shorter hospital stays, less blood loss, fewer complications, less need for narcotics, faster recovery times and smaller incisions that deliver minimal scarring. All of these outcomes are positive for the patient. However, Aston (2012) notes that despite 4600 peer-reviewed studies on the system, there remains scant evidence that patient outcomes are superior to alternatives such as laparoscopy. With a new technology, there should be ample comparative studies, but Aston notes that there are not. What comparative research does exist (Ishikawa et al., 2012) is published by the marketers of the device, and cannot be free from bias.

With respect to medical and skill education, the organization faces a challenge with the new machine. The market for skilled practitioners on DaVincis is a seller's market, so it may be difficult to acquire a practitioner. The physicians already on staff, even those requesting such a machine, will need to undergo training in order to use it effectively. For the organization, training costs will increase as its staff members will need to be trained. However, as staff capabilities on the DaVinci improve, the organization will find that there may opportunities to train others on the machine, perhaps even at a profit.

Cost containment is a distinct issue with the DaVinci machine. The machine has a high up front cost that clearly runs counter to claims of cost containment. However, it is a long-term investment. The cost of acquisition will be amortized, providing tax relief, and that needs to be taken into consideration especially at for-profit entities. For not-for-profit entities, the initial cost may be that much higher. Cost containment beyond this reflects the service advantages of the DaVinci. Several elements of the system will, if they manifest, will reduce liability risk, a major cost. Smaller incisions reduce the risk of infection, which in addition to reducing liability will also reduce patient costs, important for a not-for-profit facility. Jacob et al. (2013) also argue that robots reduce communication errors in the theater, which should also improve patient outcomes and reduce liability. So there are cost containment advantages, but these may be offset by higher training costs and even the cost of recruiting an experienced DaVinci surgeon to the team.